ABSTRACT
Background/Purpose Evaluating the long-term outcome of spontaneous intestinal perforation (SIP). Methods We studied all patients treated for SIP at our institution between January 1, 2005 and December 31, 2014. Results Twenty-three infants (13 males) with a median gestational age of 26 (range: 23-32) weeks and a median weight of 825 (range: 560-1,965) g composed this cohort. Seventeen (74%) infants had an extremely low birth weight (ELBW); nine (39%) infants were the result of multiple pregnancies.Patent ductus arteriosus (PDA) was present in 16 (70%) infants. Cyclooxygenase inhibitors were administered in 12 (52%) infants.Ten infants (seven males, 44%) were diagnosed with intraventricular hemorrhage (IVH), which was identified in the majority (8/10) at a median of 9 (range: 1-11) days prior to the perforation.All patients presented with pneumoperitoneum and underwent a laparotomy at a median age of 9 (range: 2-16) days. Twenty-one patients had an ileal perforation. A temporary stoma was placed in 21 patients, whereas two got primary anastomosis. Two (8.7%) male infants died. During the long-term follow-up period (median 6 years), six (five males) (26%) infants developed moderate to severe disabilities in combination with cerebral palsy. No surgical complications were observed. Conclusion The most important risk factor for SIP is ELBW (75%). The distal ileum is the most frequent site of perforation (88%). Approximately 40% develop IVH most often prior to the SIP. Moderate to severe neurologic disabilities are seen in more than a quarter of the children. Disability and mortality affect mostly the male sex. Long-term risks of surgical complications are very low.
Subject(s)
Ileal Diseases/diagnosis , Infant, Premature, Diseases/diagnosis , Intestinal Perforation/diagnosis , Child , Child, Preschool , Female , Follow-Up Studies , Humans , Ileal Diseases/etiology , Ileal Diseases/mortality , Ileal Diseases/surgery , Infant , Infant, Extremely Low Birth Weight , Infant, Newborn , Infant, Premature , Infant, Premature, Diseases/etiology , Infant, Premature, Diseases/mortality , Infant, Premature, Diseases/surgery , Intestinal Perforation/etiology , Intestinal Perforation/mortality , Intestinal Perforation/surgery , Male , Prognosis , Risk FactorsABSTRACT
BACKGROUND: Assessing the role of laparoscopy in the management of intussusception. METHODS: A retrospective review of children aged up to 17 years who had surgery for intussusception at this institution between 1 January 2004 and 31 December 2013. RESULTS: The cohort of 44 individuals (18 females) presented at a median age of 9 months (range 2.5 months-15.75 years) with intussusception; 36 patients had undergone a failed pneumatic reduction. Thirty-seven patients had an initial laparoscopic approach. Conversion was required in 13 individuals: inability to reduce a 'tight' intussusception in seven individuals, limited working space in four individuals, and inadequate tactile response in two individuals. Twenty-four patients (54%) had the laparoscopic approach completed. An open approach was chosen for seven individuals at a median age of 5 (range 4-11) months: three individuals had marked abdominal distension, two individuals had a pneumoperitoneum and two individuals presented with a large central mass. Together with the 13 conversions, a total of 20 patients (46%) underwent an open approach. The more distal the apex of the intussusception, the more likely open surgery was. Hospital stays for the subgroup of patients with successfully completed laparoscopic intervention (n = 24) were shorter than for the open surgery group (n = 20) with P = 0.0145, but the open procedure was used to manage the more challenging cases. The subgroup of seven infants undergoing direct open surgery were significantly younger than the remaining individuals (P = 0.0046). CONCLUSION: Laparoscopic intervention is meaningful in approximately 50% of children requiring a surgical reduction.
Subject(s)
Intussusception/surgery , Laparoscopy/methods , Adolescent , Child , Child, Preschool , Female , Humans , Infant , Length of Stay/trends , Male , Retrospective Studies , Treatment OutcomeABSTRACT
Structural equation models (SEMs) are widely recognized as the most important statistical tool for assessing the interrelationships among latent variables. This study develops a Bayesian adaptive group least absolute shrinkage and selection operator procedure to perform simultaneous model selection and estimation for semiparametric SEMs, wherein the structural equation is formulated using the additive nonparametric functions of observed and latent variables. We propose the use of basis expansions to approximate the unknown functions. By introducing adaptive penalties to the groups of basis expansions, the nonlinear, linear, or non-existent effects of observed and latent variables in the structural equation can be automatically detected. A simulation study demonstrates that the proposed method performs satisfactorily. This paper presents an application of revealing the observed and latent risk factors of diabetic kidney disease.
